A Monster Chase
A Book Analysis
This analysis of the book: “A Monster Chase” by Marion Stahl summarizes the many positions of prominent spokesmen on the issues presented in this book.
The national effort to target the medical profession began when the Clinton administration introduced the concept of “Healthcare offenses” into the general public lexicon in the proposed 1993 “Health Security Act.”
Gene Healy from the Cato Institute raised concerns of whether excessive reliance on punishment can increase harm. He pointed to the draconian approaches being adopted as discouraging physicians.
“Lumping trivial with serious transgressions undermines people’s sense of morality.” He continued by pointing out “the lack of clarity in the laws and the immense bureaucratic discretion to define standards create serious risks of corruption.” Healy maintained that rather than address the issues at stake, it “will provide new business opportunities for those particularly skilled in these arts.”
Healy stated: “Courts should be more protective of common law rights and constitutional principles. Rules that are not ascertainable after reasonable effort should be enforced only by a cease-and-desist order, not by civil or criminal penalties.”
In “A Monster Chase” the author’s example and story of Dr. Quaile, describes how the protagonist appears to have followed and complied diligently with new regulations; neither was she negligent in any legal or moral sense nor showed intentional deceits.
Nancy Dickey, M.D., former president of the American Medical Association pointed that: “demonizing the entire medical community with a broad brush of ‘fraud, waste and abuse’ trivializes real fraud and sets an adversarial tension in every patient-physician encounter.”
Grace-Marie Turner, president of the Galen Institute, in an article entitled: “HIPAA and the Criminalization of American Medicine” noted that “an expanding dragnet for ‘health care criminals’ is threatening and intimidating innocent doctors as well.” Efforts are needed, however, Turner stated that: “in its zeal to rid the nation’s health care system of waste, fraud, and abuse, Congress has passed a blizzard of new federal criminal provisions targeting the Health Care Industry.”
Turner also pointed that: “statutes are enforced by hundreds of federal agents, armed with hundreds of millions of dollars in investigatory funds. The new army of law enforcement agents has been sweeping through hospitals and doctor’s offices throughout the country to investigate a new class of ‘health care offenders.’ The federal government uses the threat of prosecution and arbitrary penalties to collect excessive settlements from doctors “guilty” of clerical errors.”
Marion Stahl stipulated that: “it’s evident that the idea of being a criminal does not enter most physicians mind. It is a foreign idea reserved for school dropouts not common among high achievers. This detail took doctors off guard and increased their intrinsic vulnerability.”
Turner states “most of HIPAA’s fraud and abuse provisions were passed despite the absence of good data on how much fraud and abuse there is, where it is, and how bad it is.” Congressional policy toward health care fraud was fueled by political polls, which in turn, were fed by misinformation and crude political expediency, or the vague need to “do something’ about waste, fraud, and abuse.” Turner explained: ‘there is a misconception that high health care costs are almost exclusively the result of fraud. Political leaders failed to educate the public on the seriousness of Medicare’s financial problems. Stopping every instance of fraud and improper billing could not come close to saving Medicare from its looming insolvency. While Congress and the Clinton administration engaged in a scam and abuse vendetta, both did an abysmal job of reforming a government system that remains a greenhouse for corruption. Clearly, it is easier for politicians to point fingers at doctors than to blame themselves for the flawed public policies that created the climate for waste in the health care system in the first place.”
Dr. Robert Waller, Chair Emeritus of the Mayo Foundation and former president of the Healthcare Leadership Council, told the National Bipartisan Commission on the Future of Medicare that: “regulatory complexity, rather than widespread fraud in the program, is the real problem.”
AMA president Daniel Johnson, M.D. stated: “why not be on the side of trying to get this fixed rather than throwing hundreds of millions of dollars at these investigations?”
After reading this book, readers yearn for a resolution not given by this book. The author intends to sensitize the reader to a problematic situation in healthcare. This book is describing the experience of a young woman, Anna, who takes upon herself to investigate the reason for the shortage of physicians. We hear of only one doctor, but become aware that many are accused of fraud. The author uses the character of Anna to analyze the process and pressing issues in prosecutions.
The narrator brings readers into a medical practice and, eventually, the ultimate results of aggressive prosecutorial approach. We witness the impact not only on employees but also on the overall healthcare and the resulting significant damages to the medical profession.
The author does not exclude the possibility that there are troubled doctors but questions whether the current disciplinary approach has worked. She shows how the guilty could easily buy their way out with the current method. The criminalization approach has damaged the trust in the medical profession, discouraged providers as well as eliminated many, and not resolved the financial concerns. In this vein, malpractice has resulted in much abuse and created a generation that blames rather than solves real problems, such as doctor’s burnout, and improvement of hospital team management. Rather than addressing and correcting underlining issues, we believe that by pointing fingers at individuals or professions, we will solve a much larger problem. The author shows the shortsightedness of the approach and its failure. The overreach by government and negative results need a solution.
This book sensitizes the reader to a reality different from what is claimed by government reports.
We have not resolved the healthcare financial crisis by revoking licenses and asking retributions and displays the results. It is a satisfaction for justice that will not last. In reality, physician’s fees represent a minuscule part of total cost. If we revoked the licenses of all providers in the US, we only solved 8% of the total annual healthcare costs in the U.S and would create a nightmare. Hence, we have not achieved much since the real culprit of the cost lies in our change in expectations of care.
The author’s positions:
1. Disciplining physicians will not resolve our healthcare financial crisis. It has created another crisis: a shortage of doctors.
2. DNA analysis has proven that our troubled justice system is punishing innocents. This story shows that victims of the system can also well-intended professionals and not only death row inmates.
Together the points made in this book are simple.
We always imagine doctors have power and fail to realize their vulnerability. The author recognized that the profession has not been in control of the press and needed a new side to the story.
Given the current beliefs (that physicians are at the root of the problem), one needed to hear a real story to understand.
In summary, readers will learn about a serious issue. Current reports have given the false impression that addressing physician fraud would resolve the healthcare financial crisis. In actuality, it appears that it has caused a new, more serious one and delayed needed action. The use of scapegoating is not unusual, yet it only offers short-term emotional anxiety and delays real solutions.
We see that excessive reliance on punishment actually can increase harm. As Gene Healy, from the Cato Institute, points out in his research:
“overuse of punitive sanction damages the moral fabric of the culture.”
Book Analysis: “A Monster Chase” by Marion Stahl